Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study.

Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.

What is the best position to place and re-evaluate an unconscious but normally breathing victim? A randomised controlled human simulation trial on children.

BACKGROUND: Current resuscitation guidelines endorse placing the unconscious and normally breathing victims in the recovery position (RP), but this technique might hinder breathing evaluation. AIM: To compare breathing evaluation and cardiac arrest detection: placing the victim in RP and checking breathing regularly, placing the victim in RP while re-evaluating breathing every minute, and placing the victim on his back, maintaining an open airway with the head-tilt-chin-lift technique and continuously checking breathing. METHODS: Schoolchildren aged 10-12 with no previous cardiopulmonary resuscitation (CPR) training, from three different primary schools were randomly allocated into groups to receive a CPR course involving one of the three strategies. Then a human simulation took place. RESULT: 192 schoolchildren (64 per group) were randomly selected and received one of the courses. 182 participants who correctly assessed the victim were compared: 16 (26.2%) out of the 59 participants using RP and checking breathing regularly detected cardiac arrest before the end of the simulation, compared to 41 (67.20%) out of 61 using RP re-evaluating breathing every minute, and 56 (90.3%) out of 62 using head-tilt-chin-lift. Statistically significant differences were found between the RP groups (p < 0.001; OR = 5.766) as well as between the Head-tilt-chin-lift and both RP groups (p < 0.001; OR = 21.094), (p = 0.002; OR = 4.553). CONCLUSION: The strategy involving head-tilt-chin-lift significantly increased the likelihood of detecting cardiac arrest. Re-evaluating every minute when the RP was used significantly increased the likelihood of detecting cardiac arrest.

Does lying in the recovery position increase the likelihood of not delivering cardiopulmonary resuscitation?

BACKGROUND: Resuscitation guidelines endorse unconscious and normally breathing out-of-hospital victims to be placed in the recovery position to secure airway patency, but recently a debate has been opened as to whether the recovery position threatens the cardiac arrest victim's safety assessment and delays the start of cardiopulmonary resuscitation. AIM: To compare the assessment of the victim's breathing arrest while placed in the recovery position versus maintaining an open airway with the continuous head tilt and chin lift technique to know whether the recovery position delays the cardiac arrest victim's assessment and the start of cardiopulmonary resuscitation. METHODS: Basic life support-trained university students were randomly divided into two groups: one received a standardized cardiopulmonary resuscitation refresher course including the recovery position and the other received a modified cardiopulmonary resuscitation course using continuous head tilt and chin lift for unconscious and spontaneously breathing patients. A human simulation test to evaluate the victim's breathing assessment was performed a week later. RESULT: In total, 59 participants with an average age of 21.9 years were included. Only 14 of 27 (51.85%) students in the recovery position group versus 23 of 28 (82.14%) in the head tilt and chin lift group p=0.006 (OR 6.571) detected breathing arrest within 2min. CONCLUSION: The recovery position hindered breathing assessment, delayed breathing arrest identification and the initiation of cardiac compressions, and significantly increased the likelihood of not starting cardiopulmonary resuscitation when compared to the results shown when the continuous head tilt and chin lift technique was used.